Today the Australian magazine Cosmos, along with a vast number of other blogs and publications, reprinted an article by Simon Singh, in slightly tweaked form, in an act of solidarity. The British Chiropractic Association has been suing Singh personally for the past 15 months, over a piece in the Guardian where he criticised the BCA for claiming that its members could treat children for colic, ear infections, asthma, prolonged crying, and sleeping and feeding conditions by manipulating their spines.

The BCA maintains that the efficacy of these treatments is well documented. Singh said that claims were made without sufficient evidence, described the treatments as “bogus”, and criticised the BCA for “happily promoting” them. At a preliminary hearing in May, to decide the meaning of this article, Mr Justice Eady ruled that Singh’s wording implied the BCA was being deliberately dishonest. Singh has repeatedly been clear that he never intended this meaning, but has been forced to defend this single utterance, out of his own pocket, at a cost that has run to six figures.

Soon we will get to the story of the backlash, but first, while you may view this as a free speech issue, there are also some specific worries raised when people sue in medicine and science.

It is possible in healthcare to do great harm, while intending to do good, and so medicine thrives on criticism: this is how ideas improve, and therefore how lives are saved. The three most highly rated articles in the latest chart from the British Medical Journal are all highly critical of medical practice. Academic conferences are often bloodbaths. To stand in the way of ideas and practices being improved through critical appraisal is not just dangerous, it is disrespectful to patients, and even if someone has been technically defamatory in their wording, it is plainly undesirable for all critical discourse in healthcare to be conducted in a stifling climate of fear. Neither the General Medical Council nor the British Medical Association have ever sued anyone for saying that their members are up to no good. I asked them. The idea is laughable.

Most of these articles drew attention to the evidence for chiropractic’s efficacy, which is often not compelling. Some discussed chiropractic’s dubious origins: it was invented by a magnet therapist, convicted of practising medicine without a licence, who suddenly decided in 1895 that 95% of all diseases are caused by displaced vertebrae, and compared himself to Christ, Muhammad and Martin Luther. Who knew?

An international petition against the BCA has been signed by professors, journalists, celebrities and more, with Ricky Gervais and Stephen Fry alongside the previous head of the Medical Research Council and the last government chief scientific adviser. There have been public meetings, with stickers and badges. But it is a ragged band of science bloggers who has done the most detailed work. Fifteen months after the case began, the BCA finally released the academic evidence it was using to support specific claims. Within 24 hours this was taken apart meticulously by bloggers, referencing primary research papers, and looking in every corner.

Professional complaints followed in May, mostly about individual chiropractors’ claims. Then, in June, blogger Simon Perry found the BCA database of 1,029 members online, containing 400 website URLs. He wrote a quick computer program to automatically identify all the chiropractors in the UK claiming to treat colic, locate their local Trading Standards office, and report them (more than 500 in total) automatically, followed up with printed letters.

Chiropractic is also a profession regulated by the General Chiropractic Council, supervised by the Health Professional Council, which are obliged to investigate all complaints. So Perry reported over 500 chiropractors to them, alleging they had made claims without adequate evidence. The GCC rejected his letter, saying it only takes individual complaints. A pile of individual complaint letters were instantly generated and delivered to their door. Astonishingly, ZenosBlog had done exactly the same thing. These 1,000 complaints are now being investigated.

You may view this as bullying individuals, and initially I had some sympathies. But my heart was hardened, reading commentary from the chiropractic and alternative therapy community, saying Singh must expect six-figure consequences for criticising them, and transgressing the letter of the law, even in just one article.

Some clue to whether chiropractors feel able to defend these complaints over the evidence for their practices came a few days later. On 8 June the McTimoney Chiropractic Association sent a confidential email to its members, which has been obtained and is available in full on Quackometer. “If you have a website,” this email begins, “take it down NOW … REMOVE all the blue MCA patient information leaflets, or any patient information leaflets of your own that state you treat whiplash, colic or other childhood problems in your clinic … IF YOU DO NOT FOLLOW THIS ADVICE, YOU MAY BE AT RISK FROM PROSECUTION. Finally, we strongly suggest you do NOT discuss this with others” – and on this they were clear – “especially patients.”

The MCA says this is a “vexatious campaign against the profession”, that it has nothing to hide, and believes its members have not intentionally breached any rules regarding their websites’ content. The entire MCA website disappeared on the same day, and continues to be nothing more than a holding page (it “is currently being updated”), but its former site, along with every single chiropractor’s website, has been archived in full online by the science blogging community, for anyone who is interested to look.

We could go on, but there are lessons from this debacle – beyond the ethical concerns over suing in the field of science and medicine – and they are clear. First, if you have reputation and superficial plausibility more than evidence to support your activities, then it may be wise to keep under the radar, rather than start expensive fights. But more interestingly than that, a ragged band of bloggers from all walks of life has, to my mind, done a better job of subjecting an entire industry’s claims to meaningful, public, scientific scrutiny than the media, the industry itself, and even its own regulator. It’s strange this task has fallen to them, but I’m glad someone is doing it, and they do it very, very well indeed.

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To the best of my knowledge, Chirospractic isn’t much of a big deal in Germany. Not even the libel suit made it to the mainstream news, even though Singh’s book has been much discussed. Be that as it may, the whole idea of settling scientific issues is scary, and it is (kind of) satisfying to see how the BCA’s strategy has backfired. I only hope that Simon Singh won’t end as a martyr for the good cause.

Terrible Al said,

Thing is though that the Mail are less backing Singh out of ideological solidarity on the subject of evidence based medicine (this shoiuld be obvious given their normal medical and science coverage), but are more concerened with the (important, don’t get me wrong, and possibly, in the short term at least, more important) issue of the abuse of libel laws and the excesses of power being wielded by Mr Justice Eady. They didn’t publish that article out of the kindness of their hearts: they did it because they fear the privacy laws that Eady is effectively writing all by himself.

naomimc said,

Further to Terrible Al. Primarily, Dacre hates Mr Justice Eady because he ruled in favour of Max Mosley and his right to a private spanking. He said it was the duty of papers to expose behaviour which is “perverted and depraved”. Has he not been on teh internets?

sophiedb said,

Well, my solitary experience of chiropractic relates to my daughter. As a newborn she simply would not turn her head to the left, which had some consequences for breastfeeding as well as making us wonder what on earth was stopping her from looking in that direction – no inticement was good enough! Eventually we did go to a chiropractor with her, who said she had most likely displaced a vertebra (ta-da!). She had six sessions of gentle massage, during/following which she did start to look to the left and breastfeed less painfully for me.

Whether this was partly or wholly down to chiropractic, I have no idea, but from our point of view it certainly worked out. I had met one woman in the waiting room one day who’d waited until her GP referred her to this clinic for the same problem, and the child was 10 months old by that point, still only looking forward or to one side. False claims of curing colic aside (DD was never colicky anyway), I’m glad we paid that money.

CoralBloom said,

stephenray said,

“Singh has repeatedly been clear that he never intended this meaning, but has been forced to defend this single utterance, out of his own pocket, at a cost that has run to six figures.”

Sorry to bang on about this, but:

in the legal situation he is in, Mr Singh has several options other than sticking by what he wrote come hell or high water. He has chosen, effectively, to defend the ‘single utterance’, out of the options that were available to him.

It would have been open to him to apologise for the use of language which might be defamatory, explaining that he did not mean to use the word ‘bogus’ in that sense, and probably pay some nominal sum to the BCA. Instead, he has defended the use of the word, but unfortunately for him, Eady J said that no, he was wrong, the ordinary meaning of the word carried connotations of deception. As a professional writer Mr Singh can hardly insist that the word means only what he wants it to mean, and nothing stronger.

Good for him, his actions have brought about a state of affairs where the BCA and chiropractic have become something of a laughing stock. And I sympathise with his position. But I’m saddened by the common acceptance of this idea that he is in the situation he is through no ‘fault’ of his own.

Mungus said,

@sophiedb – I would suggest that your daughter had a massage and that the muscles that weren’t working responded well, which is of course excellent. The smoke, mirrors and nonsense that chiros, osteos and the rest wrap round and heap upon simple massage is what causes the problem, IMHO. I speak as a former osteopath.

DrB said,

Personally I had a fantastic experience of an osteopath – I turned up on day complaining of a ‘tennis ball between my shoulder blades’, was told I had the stiffest upper back he’d ever treated, and some manipulations and massage later, walked out being able to move my upper spine proplerly for the first time in my life. I then had follow up sessions which were progressively further apart, and I was set exercises to keep the muscles moving.

i.e. I had a muscular problem and a muscular-focused treatment dealt with it.

He never once claimed to be anything other than someone specialising in postural skeletal-muscular treatments, he just got on with doing what he was actually able to do. Which is what I wish the rest of them would do.

hdogg said,

@sophiedb – it’s great that your child is now fine and healthy. However, you seem to have linked an effect – baby got better – with a cause – chiropracter.
I would instead suggest the following alternative line of thought:
1. Adults do not generally have problems turning their head (unless they have actually had some sort of collar injury)
2. Bodies usually heal on their own
3. Babies show a lot of physical traits that have nothing to do with adult life
Consequently, it would be most natural to assume that your baby got better on its own, as the human body generally does.
It’s great that you felt reassured. But, meaning no disrespect, this kind of thinking is dangerous. While you may be an intelligent, well-adjusted person, many others will hear false credit being taken by an alternative therapist and end up preferring alternative therapy. Thus, when a real problem occurs, they will seek out illusory therapies over real medicine.
This is not paranoid fantasy; distrust of mainstream medicine is a major factor in seeking alternative therapy. Further, it has been shown that people will take the advice of a more confident giver (the therapist making things up) over a less confident advisor (the GP who actually informs you of the risks and limitations), even where the advice giver has _already_ been proven to be unreliable.
I’m sure none of this applies to you, and that you would do the right thing. But many will not. This is why these people are dangerous and must be stopped.

Goblok said,

@simondsr – I lurved that article! Hilarious. We have lost a lot to the politically correct and human rights brigade that now forbids such use of language.
Whilst I do not agree with ALL he says, Ben et al might want to consider the argument that natural selection (and therefore the successful development of mankind) rests on allowing nature to weed out the weak.
It is a moral dilemma, isn’t it?

Chris said,

I would suggest that the word bogus means false, fake, or more specifically, not based on evidence, as seems to be the context here. Criticising the BCA for “happily promoting bogus treatments” is like criticising a religious organisation for happily promoting bogus ideas. Just because you believe in or advocate something stupid does not mean that you are being intentionally dishonest or deceptive. You might just be really thick. I have no doubt that (at least most) chiropractors are practising their bogus treatments with complete and genuine confidence that they work, and I don’t see any proof that Singh suggested otherwise.

There is a line here I think, that you do not cross under any circumstances, which is making unflattering and unfounded claims about the *beliefs* of a person or organisation. Confidently stating that the BCA accepts that the treatments are bogus but allows them to be used anyway requires evidence. But if you provide a diversity of peer-reviewed studies that tends to favour the premise that the treatments don’t work, stating that if the BCA wants chiropractic to be taken seriously as an evidence-based discipline they should weed out this sort of riff-raff should be completely acceptable.

Delster said,

@Mungus – I had occasion to see an osteopath (referred by Doc) following spending a couple of months in bed (enforced by bike accident). No massage was given but bones were re-alligned (cracked unnervingly) and it certainly helped. At no point did the osteo spin any mumbo jumbo, she just said that the impact and enforced reclining position had caused a few joints to stiffen and other bones to be very slightly out of place.

Re Ben’s article
“The MCA says this is a “vexatious campaign against the profession”, that it has nothing to hide”
Except maybe “the blue MCA patient information leaflets, or any patient information leaflets of your own that state you treat whiplash, colic or other childhood problems in your clinic …”

I’m the chap who wrote the letters as mentioned in Ben’s article. I’ve got another one that’s about to go out and I’m hoping to get a large number of signatories this time. Please sign it if you agree with it.

Henry said,

“a ragged band of bloggers from all walks of life has, to my mind, done a better job of subjecting an entire industry’s claims to meaningful, public, scientific scrutiny than the media”

surely ‘the ragged band of bloggers’ are *part of* the media now? rather than seeing this as ‘blogs vs the media’ we just just accept that blogging is mainstream and stop throwing rocks at each other from entrenched and polarised positions? might be more productive…

Mr Ashy said,

In terms of the judge’s decision about the meaning of the word bogus, I’m not sure how easy an appeal would be. I can think of at least three relevant factors.
1) What Singh said he meant in the article – this would seem to be the most important
2) How the word is commonly used or understood. This would be a little trickier, but in the world of the internet it isn’t too hard to see how the word is used in the context of the Guardian
3) The dictionary definition
1 and 3 certainly support singh, 2 I am not so sure about

seantheblogonaut said,

JonnyD said,

Can I say HDogg’s reply (no 16, above) is one of the most ridiculously blinkered I’ve ever seen; it could be used to dismiss the efficacy of any medical intervention anywhere, ever.
Surely the whole premise of the Bad Science Thing is to ask for evidence for claims made but issue knee-jerk rebuttals?
To dismiss the real life experience of SophieDB without knowing anything about the case is utterly unfair and unhelpful.
There seems to be no disagreement on this forum over claims that Chiropractors can solve everything from colic to third world debt are nonsense. That doesn’t justify the notion in a number of the contributions that the whole field of practice can be dismissed without further consideration of the actual question of whether it works.
I am a natural cynic when it comes to claims of CAM merchants but a few years ago I hobbled into a chiropractor’s house like a 90 year old and skipped out 40 minutes later like I’d never had a problem. If I’d got such a result from a faith healer I would have converted and joined a monastery there and then. It works – believe me, of that there is no doubt.
Surely a better suggestion would be that a proper study be carried out asking the questions such as:
1. How often does it work and on which conditions does it work?
2. If mistakes are made what are the dangers?
3. Does it work on everyone?
4. Are there dangers of using it on children?

We should also compare it against physios, osteopaths and inaction. Normally a drug wouldn’t be tested against a placebo because doing nothing is not the real world alternative – but in the case of back/neck/pelvis pain you get next to nothing useful from a GP except “take some painkillers and if it still hurts in a year or two we’ll think about sending you to a physio, if we haven’t all died of old age by then”
Chiropractic works – it really does. Don’t dismiss it out of ‘them and us’ obstinacy and ask some proper questions about it.
(sorry for being so long)

Strikesure said,

I was guided to this interesting blog by my Google analytics tool. It showed people had been directed to my clinic’s web site from this blog and the comment by JoanCrawford (number 21) seems to be the signpost.

I suspect Joan only scanned the web page that she/he refers to in ther cmment. The page covers the problems we treat in the clinic and not just chiropractic problems (these tend to be the ones listed before the “and” that Joan mentioned). I would not suggest that I could treat chronic blushing but the clinic’s Clinical Hypnotherapist does, and succesfully.

I have now ammended the web page to prevent this misunderstanding happening again.

Finally, I would suggest that if you go to your GP he/she would talk about treating your condition rather than curing you condition. So, this is not some sleight of hand that you un-charitably attributed to me but a reasonable use of english, n’est-ce pas?

inanma said,

Dattache said,

I would like to support DrB (No. 15 above) and to wave a small flag in defence of osteopaths. I have visited a variety of osteopaths in several different countries over the last 20 years. None of them have ever claimed to be able to do anything more than “click” my back, massage tight muscles and leave me moving more freely and feeling more comfortable. They have all been able to do these things more or less satisfactorily.

jumma said,

@henry “surely ‘the ragged band of bloggers’ are *part of* the media now? rather than seeing this as ‘blogs vs the media’ we just just accept that blogging is mainstream and stop throwing rocks at each other from entrenched and polarised positions? might be more productive…”

I wonder which site Ben himself is on – is he a blogger, or does he write for the Guardian?

Jinxsi said,

This is all very sad. i spoke to a chiro about this, she said most chiro’s spend 4-5 years doing one of the most difficult degree there is and then spend their life trying to help people. But some dont, she also said that regular chiro’s tend not to consider the McT chiro’s as “real chiro’s”. She also pointed out the evidence base for routine medicine was hardly good science – as we all know. Seeing bloggers bringing indescriminate mass super complaints – in revenge, isn’t good. Personally, IMHO, having been through a health based teaching hospital for 5 years (not chiro) and working in the health sector for 25 years I have come to be skeptic of mainstream medicine – which lead me to this excellent publication (can I recommend NHS plc by Allyson Pollock as a companion book) and more supportive of chiropractic work which I see as more scientific AND without big pharma influence……I suppose I must be wrong.

jesgol said,

This blog will be long winded, but it is needed to explain the many topics discussed above. I urge you to discuss this topic, but give chiropractors the chance to have their say too.

This article is a perfect example of why Simon Singh is being sued. It starts by showing a one-sided view that costs a significant loss of time, comes full circle to the admission that chiropractic helps people, and then some moron trying to plug their website – after all, its all just media hype.

I am the first to admit chiropractic is a limited scope practice. Just as neurosurgeons don’t treat ingrown toenails, chiropractors are limited to their own field of expertise. The reason that research into the treatment for infantile colic was carried out in the first place has nothing to do with smoke nor mirrors. When treating patients for neuro-musculo-skeletal disorders they noticed a reduction in other symptoms, such as the reduced frequency of colic-like episodes. Would it really be feasible to spend all that money and time on a stab in the dark? Unfortunately this body of evidence is confined to a collective of anecdotal evidence – not accepted by modern science, which sets double blind randomized controlled trials as the gold standard. Research like this is expensive and difficult to do. We don’t have a multi-billion pound pharmaceutical industry driving our profession nor the facilities to do it.

Also it is difficult to provide consistent data in these trials, as with the complexity of what we treat. Not everyone needs X amount of treatments – some people need half and some people need twice as much, which boils down to clinical experience and medical knowledge. These conditions are so subjective and multifactorial that a biomedical approach of “take two of these and call me in the morning” does not work with the chiropractic, which follows a biopsychosocial approach. I completely agree that there is a lot more evidence needed to back up the claims about infantile colic etc. and I’m afraid that might never happen with the bad, newspaper selling, dogmatic press it gets.

Some of the views concerning the origins of chiropractic are misplaced. The article is correct in stating it was D.D. Palmer, a magnetic healer, founded chiropractic a few years after osteopathy was born and around the time that x-rays were discovered. As it was back then, Palmer placed great importance on the subluxation theory as the cause of dis-ease (please note the hyphenated word dis-ease). I would like that citation about professing himself akin Christ! Haha that seems nonsense. No doubt chiropractic in its infancy had some idiosyncrasies that are laughable with the knowledge we have now. In this it is not alone. Look at the somewhat archaic practice of using leeches for blood letting, that has been reborn into modern medicine for the use in stimulating blood flow in severed limbs. The principle was hit and miss yes, but in practice it is significant.

Is chiropractic dangerous? Really? Perhaps over dramatized by Hollywood I would expect. There are two schools of thought. 1) chiropractic directly causes strokes (stoppage of blood to the brain) through occluding or even rupturing the vertebral artery during a cervical adjustment and it happens A LOT! (scientifically unknown). 2) The incidence of stroke post-chiropractic care is 1 in 1.3 million cervical adjustments, which is no higher than the risk of stroke within the general population and, if not a mere incidental finding, beyond that deemed a medical risk.

Killing a patient by direct intervention is called man slaughter and often results in a trial and sentencing. You’d think with this “risk” you’d hear more about these incidences! The truth is that some people have strokes. And people who have strokes often have neck pain. And people with neck pain often seek chiropractic care. The result? A few people have a stroke after receiving chiropractic care. It’s like walking down the street and seeing a car crash. Did you cause that car crash? No, because some cars crash and a lot of cars drive on the road, and you walk a lot next to roads.

There are people in every profession who see a good opportunity to abuse their position to make money, and sadly chiropractic is not exempt from that. I would like to think that those who put their own priorities before those of their patients are heading for a downfall and are subject to Darwin’s theory of evolution. For this reason I suggest that you visit a chiropractor on good recommendation, and should you have a favourable experience with a chiropractor, shout about it.

P.S. Edzard Ernst picks and chooses his evidence, so the basis for chirobase.org being reputable is void. He has been invited to openly discuss his views many times and has sadly declined.

Morningbird said,

Very late in the day, but feel compelled to leave a comment in support of McTimoney Chiropractic, despite my support for the efforts of Simon and bloggers to expose the bad science of the chiropractic community. After having one session with a standard chiropractor I couldn’t believe that anyone went back for a second treatment after such torture, so I was recommended to try McTimoney C. Was treated by an MC for back and neck pain and a problem I had lived with for years as a result of a car crash (not being able to lay my arm flat on the floor when lying down) disappeared within a few weeks. I visited her subsequently for neck pain several times in the next five years and each time the pain disappeared. Gainsayers will say that the pain would probably have gone away anyway, but on one occasion I was forced to wait much longer than I would have done (I was away from home) and the pain simply got worse and worse until I had treatment. I find it hard to believe this is placebo; it’s certainly not massage because there isn’t any – in the chiropractic I’ve received at any rate. Even if it is placebo however, I really don’t care. Anything to relieve that pain. We really do need a middle way here, for researchers to investigate why so many people continue to pay for a treatment that is apparently bogus but which works for them.

bigphil said,

I don’t understand what all the confusion and fighting is about among the chiropractic community. There are so many alternative forms of thereapy such as accupuncture, deep tissue massages and inversion tabless that I wonder why anyone bothers going to a chiropractor.